Senior Director, Financial Operations, Actuarial Strategy

Job Description:

• Own the financial infrastructure, controls, and operational oversight for Emory Health Plan's medical, pharmacy, and administrative costs
• Build and sustain financial operating systems, reporting cadences, budget processes, vendor financial controls, and regulatory compliance frameworks
• Own vendor financial management
• Direct Third Party Administrator and Pharmacy Benefits Manager invoice reconciliation, payment accuracy controls, and payment integrity oversight
• Oversee vendor financial performance, contract compliance, unit cost trends, and administrative fee performance
• Lead contract financial review and interpretation, flagging financial risk and aligning with budget assumptions
• Support senior leadership in TPA, PBM, and stop-loss carrier contract negotiations
• Own the regulatory compliance function and maintain compliance programs for applicable self-funded plan regulations
• Oversee regulatory filings, state filings, audits, compliance documentation, and internal controls
• Advise senior leadership on IBNR reserve management, claims lag analysis, and pharmacy rebate accounting
• Develop and maintain IBNR reserve reporting and reconciliation processes with external actuaries
• Own accounting methodology for pharmacy rebate accruals, claims runout, and complex reserve items
• Participate in annual rate-setting and pricing, providing financial inputs and operational and claims-based analysis
• Provide financial inputs for stop-loss reporting and benefits design financial modeling
• Manage and develop a team, including hiring and directing additional staff

Requirements:

• Bachelor's degree in accounting, finance, health administration, business administration, or a related field required
• 9+ years of progressive experience in health plan finance, managed care finance, or related healthcare financial operations
• Demonstrated depth in financial controls, reporting, and accounting
• CPA or equivalent accounting credential strongly preferred
• Master's degree in business administration, health administration, or a related field preferred
• Knowledge of self-funded plan regulations, including ERISA, HIPAA, ACA, Consolidated Appropriations Act transparency, and Mental Health Parity requirements
• Experience with IBNR reserve management, claims lag analysis, pharmacy rebate accounting, financial controls, reporting, accounting, regulatory filings, audits, and vendor financial management
• Ability to manage and develop a team, hire and direct additional staff, and provide performance management

Benefits:

• Regular full-time employment
• Remote work classification: Full Remote – Monthly
• Occasional supported visits to an Emory University location
• Equal opportunity employment
• Reasonable accommodations for qualified individuals with disabilities